Provider Demographics
NPI:1649894247
Name:RYBISKI, MARY KAY (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:RYBISKI
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CLIFTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2468
Mailing Address - Country:US
Mailing Address - Phone:419-512-7131
Mailing Address - Fax:
Practice Address - Street 1:360 WATERLOO DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6554
Practice Address - Country:US
Practice Address - Phone:419-512-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-30572163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant